This paper describes the immediate impact of conflict following Kenya’s presidential elections on 27 December 2007 with regard to clinic attendance and medication adherence for HIV-infected children cared for within the USAID-Academic Model Providing Access to Healthcare (AMPATH) in western Kenya. The researchers conducted a mixed methods analysis that included a retrospective cohort analysis, as well as key informant interviews with pediatric healthcare providers. They found that, during this period of humanitarian crisis, the vulnerable, HIV-infected paediatric population had disruptions in clinical care and in medication adherence, putting children at risk for viral resistance and increased morbidity. However, unique programme strengths may have minimised these disruptions.
Equitable health services
This article discusses health sector reform experiences of four developing countries, including Tanzania, and identifies the lessons learned. Findings suggest that decentralisation works effectively while implementing primary and secondary health programmes. Decentralisation of power and authority to local authorities requires strengthening and supporting these units. Community participation facilitates recruitment and development of field workers, facility improvement and service delivery. For providing financial protection to the poor, there is a need to review user fees and develop affordable health insurance with an exemption mechanism. There is no uniform health sector reform approach for all countries – policy makers must examine the context and determine the reform measures that constitute the best means in terms of equity, efficiency and sustainability.
New Health Minister, Dr Aaron Motsoaledi has announced five key priorities for action, one of which is to strengthen the quality of care in the health service. To succeed in boosting service delivery, the new Health Minister identified four key areas he will be giving his immediate attention in the next few weeks: the official launch the prevention of mother-to-child HIV transmission acceleration plan, a new team that will deal with norms and standards between national, provincial and district health systems, a future meeting of provincial health MECs to come up with cost-containment measures or austerity measures to curb over-spending, and a consultation with his counterparts within the Inter-Ministerial Committee to speedily resolve the issues around the occupational-specific dispensation. But Motsoaledi was thin on detail about how he plans to address the issues.
This study sought to assess progress in South Africa with respect to deinstitutionalisation and the integration of mental health into primary health care, with a view to understanding the resource implications of these processes at district level. A situational analysis in one district site, typical of rural areas in South Africa, was conducted, based on qualitative interviews with key stakeholders and the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS). The decentralisation process remains largely limited to emergency management of psychiatric patients and ongoing psychopharmacological care of patients with stabilised chronic conditions. Similar to other low- to middle-income countries, deinstitutionalisation and comprehensive integrated mental health care in South Africa is hampered by a lack of resources for mental health care within the primary health care resource package, as well as the inefficient use of existing mental health resources.
This paper explores the organisation of health care work in primary care clinics in Cape Town by analysing two elements of clinic organisation as rituals: a formal, policy-driven element of care – directly observed therapy for tuberculosis patients – and an informal ritual – morning prayers in the clinic. Seven clinics providing care to people with tuberculosis were sampled. Findings suggest that, rather than seeing the ritualised aspects of clinic activities as merely traditional elements of care that potentially interfere with the application of good practice, it is essential to understand their symbolic value if their contribution to health care organisation is to be recognised. These rituals embody the conflicting values of patients and staff in these clinics and reinforce asymmetrical relations of power between different constituencies, strengthening conventional modes of provider-patient interaction.
Government has revealed its National Influenza Pandemic Preparedness Plan in the event of an outbreak of swine flu in the country. Dr. Frew Benson, the Chief Director of Communicable Diseases in the Department of Health, explained to the media how the team would respond after being alerted of a suspected case. ‘They would go out to that particular case, investigate, take all the epidemiological data around this case, make certain that the case is isolated and trace all the contacts of this case. They will then make sure, if the case meets the criteria for treatment with anti-virals’, he said. The department has assured the public that it has stockpiled more than enough batches of the anti-viral drug, Tamiflu, which has been found to be effective against swine flu. ‘We’ve got 100,000 doses (of Tamiflu) and more available if need be. We have more than 10 times more than was needed in the Mexican outbreak,’ he added.
Responsibility to take forward a still in-progress framework to cope with global influenza pandemics is now in the hands of the World Health Organization Director General Margaret Chan. The framework is intended to set forth guidelines for the sharing of viruses, vaccines, and other benefits related to pandemic strains of influenza. This includes mechanisms for tracing and reporting outbreaks, as well as for capacity building, technology transfer, and stockpiles of vaccines. It also includes a model binding contract for entities sharing viruses with pandemic potential.
The cholera epidemic in southern Africa continues to abate, but international and local health authorities stress the need to remain vigilant, the United Nations has reported. There were a total of 4,579 new cases between 3 and 17 April in the nine countries – Angola, Botswana, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe – affected by the often fatal disease since August 2008. During the two weeks preceding 3 April, 6,460 new cases were reported. Authorities warn, however, that cholera could re-appear in the coming one to three weeks, when waters from flooding in the region, which has affected more than 1.2 million people, subside and become stagnant.
There were 1.37 million new TB cases in 2007 among HIV-infected people and 456,000 deaths, says a new global TB report by the World Health Organization. One out of four TB deaths is HIV-related, twice as many as previously recognised. Despite an improvement in the quality of the country data, which are now more representative and available from more countries than in previous years, these shocking findings point to an urgent need to find, prevent and treat tuberculosis in people living with HIV. According to Dr Margaret Chan, Director-General of WHO, 'We need to test for HIV in all patients with TB in order to provide prevention, treatment and care. Countries can only do that through stronger collaborative programmes and stronger health systems that address both diseases,' she said.
Haemorrhage is the leading causes of obstetric mortality. Studies show that active management of third stage of labour (AMTSL) reduces post partum haemorrhage. This study describes the practice of AMTSL and barriers to its effective use in Tanzania. Correct practice of AMTSL was observed in only 7% of 251 deliveries. Knowledge and practice of AMTSL is very low and STGs are not updated on correct AMTSL practice. The drugs for AMTSL are available and stored at the right conditions in nearly all facilities. All providers used ergometrine for AMTSL instead of oxytocin as recommended by ICM/FIGO. The study also observed harmful practices during delivery. These findings indicate that there is need for updating the STGs, curricula and training of health providers on AMTSL and monitoring its practice.